Case 8

The following day, you receive these biopsy results:

Liver – Diffuse, mixed microvesicular lipidosis. Bile deposition between hepatocytes consistent with intrahepatic cholestasis. No evidence of inflammatory or neoplastic processes noted.

Small intestine – Diffuse, moderate lymphoplasmacytic inflammation with crypt hyperplasia and blunted villi.

QUESTION 9

What is your treatment plan for Misou in light of the hepatic and intestinal histopathologic lesions?

a) Continue the tube feedings and previous medications as before, and add prednisone at 1 mg/kg twice daily.

b) Start prednisone twice a day and have the owners come back in so you can remove the feeding tube since the prednisone will stimulate her to eat on her own.

c) For now, continue the feedings and medications as before and wait at least a week before starting prednisone to allow time to heal from surgery.

d) Change her diet to a hydrolyzed protein diet and continue medications as before.

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